Adopting an International Child with Special Needs
There are many questions those of you who are considering the adoption of a child with special needs, would like answered. Over twenty years of working directly with over 1000 children with special needs and their families have helped me form the opinion that no absolutes exist when looking for adoption answers regarding this population of children. In the following pages, I have attempted to lay out for you, the potential adoptive parent(s), some issues to reflect upon and suggestions you may find useful. REFERRAL INFORMATION
Adoptive families often wonder how much information they should expect in a referral of a child from overseas. As child care standards and medical care
differs significantly from, country to country and often from program to program within the same country, each program has its own limitations as to the information they provide. Therefore, it is impossible to say what should constitute a realistic expectation. You should assess the standard referral information provided by the program you are considering and if you are comfortable with it, this program may be a good option for you. At this point, I suggest that you talk to other families who have adopted through this program. If you feel that certain information must be included in your referral for you to proceed with a placement, it will be necessary for you to ask your US agency if your chosen program includes that information.
I suggest that you consider the following when choosing a program:
-What kind of medical information does your agency expect to receive from the international program you are interested in (e.g. birth history, medical concerns, medical treatment medical/developmental test results)?
-Does the overseas agency have the ability to obtain more information if you or your medical doctor requests it?
-Is the US agency receptive to asking questions of their representative on your behalf?
-Who does the agency representative, or the international agency, consult with overseas regarding the special needs children, and what are their qualifications?
-What experience does the person identifying the children have in special needs adoption? COMMUNITY INFORMATION
The first thing you will probably think of doing, is taking your referral to a doctor that you trust. I have found however, that families can be frustrated and overwhelmed by their initial contacts with the medical community even when they consult with someone they trust. It is often difficult for families to know what questions to ask once they meet with their doctor. Those who have the most success in this area are adopters who have prepared ahead of time and have done their homework regarding the information they have received on the child's referral. If the child who has been referred, has a specific handicapping condition, I suggest that you visit your local library and/or contact the appropriate organization, to inform yourself about that condition. The information you accumulate within the first few days of doing this "homework" may be startling. Remember, that there are varying degrees of severity that appear for different diagnoses. What is encompassed under one label can range from mild to severe and, before panic sets in, a clear picture of where the child you are considering fits in that continuum is important. This time spent information gathering, will better prepare you to discuss the child's prognosis with your doctor as she/he explains how the diagnosis affects this particular child.
Involvement with parent groups that meet to discuss the concerns of children similar to the child whose referral you are holding, is very important. This will help you immensely in putting the medical information into perspective by learning about the day-to-day lives of these children. Parents
both by birth and by adoption offer their support in a non-threatening environment. Through these conversations, you will be receiving a great deal of new information and it is an emotional time. Please reflect upon what you have heard and learned before you make any final decisions. MEDICAL RESOURCES
There are many questions that the doctor may want to ask you, and there are many questions you will wish to ask the doctor. Before you get to these however, I feel that it is imperative that from the outset you make it clear to your doctor that you have already made the decision to proceed with an international adoption, that you have already made the decision to accept the referral of a special needs child, and that what you want from this doctor is the information and guidance she/he would give to any family
who entered the office with their birth child, asking the same types of questions. Explain to the doctor that you understand that she/he is not making the decision for you; she/he is only helping you to become informed. Explain that you are not asking whether or not you should proceed with that child. REMEMBER: The decision you made to proceed or not to proceed with a child referral is a decision only YOU can make!
Many people are angry or frustrated when the doctor they consult does not give them definitive answers. Please understand, that the medical doctor who is giving information on a child from another country is put into a precarious position. First of all, the doctor you are consulting obviously has not made the original diagnosis, and is being asked to give opinions on someone else's expertise. This doctor does not usually know specifically how this child was diagnosed, what tests were given to reach the diagnosis, what equipment was used for these tests, whether the x-rays, EKG's, echoes, sonograms, or EEG's were interpreted accurately, whether the blood chemistry was examined accurately, and whether there are genetic or chromosomal factors which may play a part in this child's diagnosis. Certainly, this all explains that there are hazards to interpretations of test results or readings by another doctor. As a result your consulting doctor is likely to qualify her/his statements regarding this child and the child's present and future situation. SECOND OPINION?
The question of seeking a second opinion is often raised by families who are adopting children with special needs. It is my opinion that, if you are considering adding a child with a medical concern, you should check with more than one physician. Medicine is not an exact science and there are usually many different opinions on any one issue, especially when that issue is seen infrequently in the United States. I suggest that you ask the physician you are consulting, if they have had professional experience with children from other countries or cultures.
You may find that as you talk to a variety of medical people, you will come to realize that diverse philosophies and treatments for the same condition in the same community can exist. Before making your final decision, it is important for you to take all of the information you have received from the specialists and decide how much, if any, of this information contains adoption bias by the doctor who was answering your questions. Remember that physicians
can hold the same prejudices against foreign and special needs children that others in the community hold. International adoption is NOT without controversy. REQUESTS FOR ADDITIONAL INFORMATION
Frequently, the medical personnel consulted request further information regarding the child's medical condition. In some programs, this would just not be possible and in those instances you will need to make a final decision with the information you already have. Often, the tests or information which have been requested are either not within the capabilities of the medical or social work staff of the country where the child is presently living, or test facilities and/or equipment are unavailable You will need to ask the advice of your agency as to whether the information requested is appropriate and realistic for your particular program. It is your right to request any and all information you feel you may need in order to make a decision regarding a particular referral. It is the agency's responsibility to be knowledgeable regarding the international agency's attitudes towards requests for more medical information. You and your agency must be aware of the sensitivities of the country from which the referral was sent, and how this request will be received.
Even if you cannot handle, and are not ready to accept, the medical concerns of the child being referred, this child may be perfect for another family. This is not to say that the request for additional information is inappropriate. In many cases, this information is not only appropriate, but is often appreciated by the overseas agency who will have an opportunity to learn more about this child and other children with similar medical concerns. At the same time, indecision might hold up or take away an opportunity for the child's placement
or referral to another family, so when you make that request, do so, with serious intent on proceeding. DECISION-MAKING
Can you truthfully say that you have looked at all your concerns objectively? You may still be concerned about some issues, but do you feel deep down that this is the right decision? This is the time to question your choice. If the unanswered questions at this point are extremely disturbing, this may not be the right child for you. It is wonderful to believe that the child who has not thrived in his or her homeland will respond to your love and attention. This has proved to be true in many cases, but not all of them. Realistic expectations are a must, because unfortunately, love does not conquer all!
A failure-to-thrive or institutionalized child, a developmentally delayed child, or a child with a parental history of substance abuse, may not respond, catch up and accomplish the dreams you have envisioned. That child may always remain delayed or unstable. So many people can spend long hours, days or months working with a child when they feel the outcome will be a positive one. Can you still feel that child is a part of you, if the outcome is not as positive as you had hoped?
A wonderful aid in decision-making is to spend some time with children who have similar physical challenges to the child you have on referral. Visit the child at their home or school, if possible. If you see no problem accepting what you observe at this point, project some of your fantasies to the teen years, or visit with a teen and their parents. Are you still comfortable? All of us have images of ourselves that we hope are true. We look at children and families that have "made it" and we say we can do that too. We want to see ourselves as strong enough and capable enough to endure whatever challenges life presents. Be sure that you are being realistic regarding your strengths and weaknesses.
You must feel comfortable proceeding with your adoption plans. It is imperative that you remember that adoption, like birth, is a lifetime commitment SUMMARY
I have worked with over 1000 children with special needs and their adoptive families during my career. I have occasionally seen families experience heartache, disruption and divorce. Some of these families feel that the major stress in their lives began with the addition of their child with special needs. The majority of families however, feel that the addition of their child with special needs was one of the greatest experiences of their lives. Much of what I have written here may appear to be disheartening and pessimistic. I truly don't mean it to be that. The point I am trying to get across, more than any other, is that adding a child with special needs to your family requires realistic and objective decision-making.
There is no parenting that is easy and without problems. The addition of a child with special needs can enhance the difficulties and the problems faced in parenting, but done correctly, it can also be a joyous experience. An informed decision can make the difficult times easier to manage and be the most rewarding and fulfilling decision in the lives of both you and your new child. ABOUT THE AUTHOR
: Teri Bell is presently the Special Needs Coordinator for Americans for International Aid and Adoption in Michigan. She is a licensed social worker who holds a masters degree in Early Childhood Special Education and has worked internationally for the adoption of special needs children for over twenty years.
© Roots & Wings Adoption Magazine
Credits: Teri Bell